School-Based Interventions for Children with Behavioral Difficulties: Suboptimal Implementation of Evidence-Based Practices

Children with behavioral difficulties and their teachers frequently experience challenges at school, leading to school-based interventions. Here, we evaluated the utilization and evidence-base of school-based interventions for behavioral difficulties. We conducted a survey among 102 school mental health professionals and asked about their utilization of 22 school-based interventions, whereafter we evaluated the evidence-base of these interventions. We also assessed professionals’ attitudes towards evidence-based practice, knowledge about behavioral problems, and their educational background, to analyze associations with the use of evidence-based interventions. We found large heterogeneity in evidence-based practice: 18.6% of school mental health professionals only used evidence-based interventions, and another 38.2% reported to use at least one evidence-based intervention alongside the use of interventions without evidence base. However, 26.5% of the professionals did use interventions for children with behavioral difficulties, but none of these was evidence-based, and 16.7% did not use any intervention at all. In addition, we found that about half of the currently used school-based interventions for children with behavioral difficulties lack empirical support and that interventions that are evidence-based and specifically developed for children with behavioral difficulties are hardly used. None of our potential predictors were related to the use of evidence-based interventions. We underscore the need for a better implementation of effective school-based interventions for children with behavioral difficulties. This would require a multifaceted approach encompassing research into promising interventions, de-implementation of interventions that lack evidence, more insight into factors facilitating the implementation of evidence-based interventions, and more rigorous support for implementing evidence-based interventions in schools.